Lumlertgul D, Boonyaprapa S, Bunnachak D, Thanachaikun N, Praisontarangkul O A, Phornphutkul K, Keoplung M
Division of Nephrology, Faculty of Medicine, Chiang Mai University, Thailand.
Ren Fail. 1991;13(1):15-22. doi: 10.3109/08860229109022141.
Obstructive jaundice has been known to cause severe hemodynamic disturbance. The present study was therefore designed to assess the cardiac involvement in jaundiced patients. The multiple-gated blood pool cardioscintigraphic studies were done in 9 jaundiced patients who had either cholestatic or obstructive jaundice (mean total bilirubin 29.30 +/- 3.30 mg/dL), and in 8 normal volunteers (total bilirubin less than 1 mg%). None of the patients had evidences of obvious cirrhosis, intrinisic heart disease, or septicemia. Following intravenous dobutamine there was comparable change of blood pressure and heart rate in both groups. However the response of left ventricular ejection fraction (LVEF) to dobutamine (10 micrograms/kg/min x 5 min) was strikingly blunted in the jaundiced patients as compared to that seen in the normal controls (3.56 +/- 0.9 vs. 12.7 +/- 2.2%, p less than 0.005). Our present data thus show that there is blunted myocardial contractile response to the inotropic stimulation in jaundiced patients. Such myocardial refractoriness to beta-1 stimulation may contribute to the susceptibility of jaundiced patients to postoperative shock and acute renal failure.
众所周知，梗阻性黄疸会引起严重的血流动力学紊乱。因此，本研究旨在评估黄疸患者的心脏受累情况。对9例患有胆汁淤积性或梗阻性黄疸（平均总胆红素29.30 +/- 3.30mg/dL）的黄疸患者和8名正常志愿者（总胆红素低于1mg%）进行了多门控心血池心脏闪烁扫描研究。所有患者均无明显肝硬化、原发性心脏病或败血症的证据。静脉注射多巴酚丁胺后，两组的血压和心率都有类似的变化。然而，与正常对照组相比，黄疸患者左心室射血分数（LVEF）对多巴酚丁胺（10微克/千克/分钟×5分钟）的反应明显减弱（3.56 +/- 0.9对12.7 +/- 2.2%，p<0.005）。我们目前的数据表明，黄疸患者对正性肌力刺激的心肌收缩反应减弱。这种对β-1刺激的心肌不应性可能导致黄疸患者易患术后休克和急性肾衰竭。
